Sharon Lisa Letizio, MSW LICSW
Individual provider Active NPI Social Worker · Waconia, MN
NPI 1972504041 · NPPES record last updated Feb 19, 2014
Key facts
- NPI
- 1972504041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 09412 (MN)
- Practice address
- 540 E 1St St
Waconia, MN 55387-1601 - Phone
- (952) 442-4437
- Fax
- (952) 442-3084
- NPI assigned
- Aug 10, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Carver County
Practice addresses (Care Compare)
540 E 1St St
Waconia, MN 55387-1601
Phone (952) 442-4437
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111222000544 | MN | Practitioner - Clinical Social Worker | 3173799145 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09412 | MN | MD | Social Worker |
| 9412 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carver County | Current |
Accepting new patients |
Locations
540 E 1st St
Waconia, MN 55387
Phone (952) 442-4437
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 09412 | MN | Yes |
Addresses
Primary practice location
540 E 1St St
Waconia, MN 55387-1601
Mailing address
540 E 1St St
Waconia, MN 55387-1601
Phone (952) 442-4437
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6295013 | Other | MN | UBH-MEDICA |
| 802957100 | Medicaid | MN | |
| 88D04LE | Other | MN | BCBS |
| 1023604 | Other | MN | PREFERRED ONE |
| HP30776 | Other | MN | HEALTH PARTNERS |
Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.